'A vital role to play': U of T grad on the growing need for occupational therapists in hospital ERs

Nadine Narain couldn’t have imagined working in an emergency department upon graduating from the University of Toronto’s department of occupational science and occupational therapy in the Temerty Faculty of Medicine. 

Five years later, Narain is now an adjunct lecturer in the department and has a varied career that has included work with children, in home health care, acute care and palliative care.

She’s also part of what she hopes will become a growing trend: occupational therapists who work in the ER to help reduce the length of stay and unnecessary hospital admissions. As well, occupational therapists help facilitate safe discharges and prevent hospital re-admissions by ensuring patients have adequate supports at home and in the community.

Narain recently spoke with writer Erin Howe about her work and how it has been impacted by the pandemic.

What kind of work do you do at the hospital?

I’m part of an interdisciplinary team at Sunnybrook Health Sciences Centre. We facilitate safe discharges into the community. To do this, I conduct functional assessments, especially for patients with functional or cognitive decline. I collaborate with the team to ensure patients are safe to return home. If they’re not, we make the recommendations.

In discharge planning for patients returning home, I provide education and recommendations on resources to optimize their safety, independence and well-being. For example, any equipment they may need – like grab bars for their bathtub or a walker, support for personal care, meal preparation, medication management and other basic daily activities.

As part of my assessment, I also check in with caregivers to ensure they feel supported and have resources to cope with burnout.

As well, I might see people who may have a concussion or mild traumatic brain injury. I help assess them from a cognitive perspective for what kinds of follow up might benefit them, and provide education on managing with their symptoms.

Our goal is to set people up for success at discharge so they’re less likely to return to the hospital.

During the pandemic, I’ve observed an increase in issues like domestic violence, falls, functional decline and failure to cope at home. These were all pre-existing issues, but they came to the forefront as a result of the pandemic.

What kind of demand is there for occupational therapy expertise in emergency departments?

When I was in school, I didn’t imagine this kind of opportunity. But when I saw that posting, I thought it was very exciting.

At this point, there aren’t many occupational therapists working in Canadian emergency departments, but I hope to see that change in the future. There’s no doubt we have a vital role to play in the ED to optimize quality of care.

You’ve worked with people recovering from COVID-19. How can occupational therapy help people through that journey?

I worked in a COVID-designated ICU and field hospital, and had a front-seat view of the impact COVID-19 has on physical and cognitive functioning.

Patients can become so deconditioned that they have difficulty completing basic tasks like personal care, walking and getting out of bed. My role was to help them regain their independence and ensure they were safe enough to be discharged home or to rehab.

Some patients also have difficulty with memory and concentration following their illness. I also often provide education on how to manage post-COVID symptoms and therapy to advance peoples’ functional abilities.

Can you tell me about the work you do in the community and with people experiencing homelessness?

Many of my clients in community are vulnerable. They’re homeless, low-income or frail and manage complex health issues and struggle with psycho-social issues.

Sometimes, a person may not have a home address, so I’ll meet them in the street or in a place that feels safe and convenient for them.

I've met a client before in a pharmacy. He had an issue with his walker’s handle height not being appropriate for him. So, I arranged to meet him where he picks up his medications and I adjusted the walker and chatted with him to see how things were going.

I also meet clients at their group homes or at a hospice. In those settings, I help provide education on safe functional mobility, determine what a client’s equipment needs are and ensure they receive it.

What sparked your interest in occupational therapy?

I’m inspired by my parents’ compassion and empathy for others – especially when I reflect on the time they spent as caregivers for some of our loved ones.

During my undergrad, I had the privilege of working with Professor Emerita Judith Friedland, an icon in my field. She posted an opportunity to work in her lab and I felt like the stars had aligned. I worked with her on her book, Restoring the Spirit: The Beginnings of Occupational Therapy in Canada, 1890-1930. The experience cemented my interest. She remains an inspiration for her advocacy, leadership and compassion.

As a student, I co-founded a student chapter of a non-profit organization, Global Brigades, which led a project in rural Honduras to build local capacity for rehabilitation care. Deb Cameron, one of my many mentors at U of T and the department of occupational science and occupational therapy’s international field work co-ordinator, was a key support.

Lawrence Loh, an [adjunct] professor at the Dalla Lana School of Public Health’s Centre for Global Health, provided guidance on sustainable, ethical and responsible volunteering, which opened my eyes to working with vulnerable and multicultural populations here in Canada.

My previous research supervisor and mentor [Assistant Professor] Andrea Duncan continues to be a support to me as well.

What’s the most rewarding part of your work?

The most rewarding element of my work is to be able to remove barriers for my clients in the community to live safely, independently and with dignity. Ultimately, these things help prevent people going to the hospital, which has taken on a new importance during the pandemic.

Working in palliative and end-of-life care within the community has been really meaningful over the last few years.

I help clients adapt to changing goals and relieve distress they may be experiencing at that point in life while dealing with a terminal illness. And I work closely with the Palliative Education and Care for the Homeless (PEACH) team, where I'm able to provide person-centered care to vulnerable populations.

I feel privileged to help clients live with dignity and independence.